The vanguard and the people it serves

A mental health trust alliance to transform acute care in the West Midlands.

This vanguard aims to share best practice and create new ways of working for specialist mental health services that are more effective, efficient and offer consistent value for money.

The vanguard partners include:

Birmingham and Solihull Mental Health NHS Foundation Trust;

Black Country Partnership NHS Foundation Trust

Dudley and Walsall Mental Health Partnership NHS Trust

Coventry and Warwickshire Partnership NHS Trust

Together they cover a population of 3.4 million.

What is changing?

Mental Health Alliance for Excellence, Resilience, Innovation and Training (MERIT) will focus on three priority areas to address the greatest challenges faced by urban mental health services – crisis care and reduction of risk, recovery and rehabilitation, and every day services.

The vanguard partners will aim to rapidly improve service quality and increase efficiency by working better together to provide a consistent service that takes into account local needs, reduces variations in care and spreads best practice.

Service users will benefit from a co-ordinated emergency response and faster decision making (for example, it will be possible to discharge people seven days a week rather than only on week days). Their care plans will also be shared by all the health professionals involved in their care, so that they only need one assessment and to tell their story once.

The vanguard will also provide more support for recovery in the community, to reduce the chance of service users becoming unwell again and limit the unnecessary time spent in A&E or police cells. If inpatient care is needed, this will be managed centrally to maximise availability and increase flexibility across the four trusts, meaning service users are more likely to stay closer to home if a bed is not available in their immediate area.

Key benefits

More community support will reduce avoidable hospital admissions

Inpatient care closer to home

More efficient services will offer better value for money for the NHS

Better sharing of information and expertise

More flexible workforce across the West Midlands

Recovery models which aim to prevent relapse or readmission back to secondary care.

Contact MERIT

Case studies

1. Improving care for people in mental health crisis

MERIT will create a model of excellence in crisis care across the four partner trusts to promote quality improvement, consistency of practice and better collaborative working and produce a blueprint which can be replicated elsewhere.

Prof George Tadros, clinical director for urgent care at Birmingham and Solihull Mental Health NHS Foundation Trust and lead for MERIT’s crisis care work stream, said: “Our approach is to ensure consistency in care for service users wherever they are in the West Midlands region. To achieve this we will agree common care pathways, language and standards across our four trusts.

“When a service user experiences a mental health crisis, they or their carer will have access to an interactive website to show them where they can go for help. A simple click-and-find page will guide people to our urgent care services, building on nationally recognised crisis services already in place in the West Midlands such as Street Triage.

“An integrated patient record system across the four trusts will mean that wherever a service user is, regardless of which trust’s area they come from, they will receive rapid help.

“And if they need to be admitted to as an inpatient, a single bed management system will allow us to identify where beds are available at any one time across all four trusts using visual electronic boards to provide ‘at a glance’ information, supported by agreed operational processes. This means they will be less likely to be placed in a bed outside our combined area, far from their families and carers, and instead provide care closer to home.”

“MERIT will also focus on closer co-ordination of workforce management and training to create a broadly-skilled workforce across the patch. Colleagues can then respond quickly and flexibly to staffing issues at a local and regional level and reduce dependence upon agency staff, creating greater consistency and continuity of care.”

2. Focusing on recovery in mental health

MERIT is committed to improving care for people with mental health problems and is involving local people in developing the service to help patients in recovery.

The alliance will explore different models of recovery, share best practice and analyse service user feedback in a bid to be more responsive to the needs of patients in the community. By improving the way we work we will help to prevent relapses and readmission back to secondary care wherever possible.

Dr Anne Crawford-Docherty, consultant clinical psychologist at Black Country Partnership NHS Foundation Trust and lead for MERIT’s recovery workstream, said: “Our work can’t just involve us going out and telling people how things are going to be. It’s about asking questions. There are experts by profession and there are experts by experience – it’s a collaboration.

“Previously, when someone was in mental health crisis they were treated in hospital for that crisis, then discharged and their recovery treatment would begin.

“Either they would be offered the standard course of therapy and ‘sent on their way’ or they would go into more specialist mental health care where they would be diagnosed and given drugs for one or more medical conditions. They would then work with a psychiatrist for as long as it might take for them to be discharged from secondary care.

“Our work now recognises that recovery should begin when the person first makes contact rather than being seen as something that happens after the crisis has been treated. We need to ensure that every interaction we have with an individual experiencing mental health problems promotes recovery and hope.”

As part of a series of learning workshops, an event in Birmingham city centre in March brought together NHS staff, people who use mental health services and their carers to talk about what recovery means and how MERIT can facilitate patient recovery and improve their quality of life.

Dr Crawford-Docherty added: “It’s important that we engage and involve people in the community to aid the recovery process. It’s about asking ‘What do people who don’t have mental health problems do or need in their lives that makes them happy, functional and successful?’ We then apply those same things to people who do have mental health problems to help identify what we can do to help. People with mental health problems are no different to anyone else – we all need the same things.

“It has been said in the past that once someone opened the door to the hospital, the door to the community closed behind them – we want to make sure that door is always kept open.”

The vanguard will also look at areas such as how employers can work with mental health services to help people back into work, and make a record of groups in the community which can help people in recovery.

Patients will benefit from a better overall experience with holistic support and less need for crisis care, which will also reduce the demand on NHS resources.